# Assessing Quality of VA and Community Care in the MISSION Era

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: With the goal of improving Veteran access to timely services, the MISSION Act is shifting the
VA from a tightly integrated system to one that is more “dis-integrated,” with a substantial number of specialty
visits now provided by community providers. The use of VA-purchased community care (VA-CC) could
improve access for Veterans, but could also increase fragmentation of care, potentially resulting in delays,
redundancies, and less coordinated treatment plans. While multiple previous studies have shown a quality
advantage for VA relative to community care (CC), we have little understanding of how fragmentation will
impact timeliness and quality of care, especially for high-risk conditions such as cancer care.
Significance: Fragmented care is a common, serious, and urgent problem for individuals with cancer. This
study, which is responsive to several HSR&D research priorities, will examine the quality of cancer care after
the institution of CHOICE and MISSION, whether the efforts to coordinate VA-CC are successful in
maintaining measured quality, and the degree of risk to quality for patients who divide their care between
systems. Results can be used by our VA partners and Veterans to understand variation and deficits in quality.
Innovation & Impact: This project focuses on systems of care and the potential risks and benefits to quality
when policy incentivizes movement across systems, and develops measures that can be used for monitoring
and targeting efforts to change practice and improve cancer care quality received by Veterans in all settings.
Key products: 1) a report of cancer care quality across VA-delivered and VA-purchased CC; 2) an assessment of
quality for providers in the community who contract with VA relative to geographically proximate providers
who do not; 3) a set of cancer quality measures ready for implementation and new measures identified as
appropriate targets for future implementation; 4) a set of measures requiring further testing and development;
and 5) approaches to enhance implementation in VA and non-VA settings.
Specific Aims: 1. Adapt and extend a set of claims and registry-based measures designed to assess cancer
care quality in national US health systems for use within VA; 2. Compare the quality of cancer care for Veterans
who receive their cancer care within an integrated system to those receiving more fragmented care across
systems, and examine differences in measure performance across key predictor variables; and 3. Conduct a
Stakeholder Expert Panel (SEP) to recommend a cancer performance measurement set for tracking quality of
cancer care in VA and/or non-VA settings and an agenda for near term implementation.
Methodology: We will operationalize previously designed claims-based measures of cancer care in VA data
and extend the measure set (with additional prostate cancer measures). We will compare quality measure
performance for Veterans over 64: 1) Receiving VA-delivered care only vs. receiving any...

## Key facts

- **NIH application ID:** 10749879
- **Project number:** 5I01HX003421-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** TIMOTHY P. HOFER
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-01-01 → 2026-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10749879

## Citation

> US National Institutes of Health, RePORTER application 10749879, Assessing Quality of VA and Community Care in the MISSION Era (5I01HX003421-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10749879. Licensed CC0.

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